This document summarizes key points about the management of acute pancreatitis. It discusses the epidemiology, etiology, clinical presentation, diagnostic evaluation, determination of severity, treatment approaches, and complications of acute pancreatitis. Management depends on determining if the pancreatitis is mild, moderate, or severe based on the presence of organ failure or local complications on imaging. Nutritional support, antibiotics, and drainage of fluid collections are addressed.

1. Acute Pancreatitis Management Conference LTC J. David Horwhat, MD Assistant Chief, GI WRAMC

12. Tityus trinitatus Tityus serrulatus

16. Ranson et al. Radiology, 1990;174:331 † Sn 73%, Sp 77% * > 7 d in ICU MORTALITY † MORBIDITY *

18. Pancreatitis Outcome Prediction Score

22. Acute Pancreatitis INTERSTITIAL (Edematous) 80% NECROTIZING 20% INFECTED NECROSIS 70% INFLAMMATORY MASS STERILE NECROSIS 30% HEALING CHRONIC PSEUDOCYST PANCREATIC ABSCESS

27. CT Findings Tail Indistinct Intraperitoneal fluid PANC LIVER

28. CT Findings Severe Pancreatitis Peripancreatic edema and inflammation Unenhancing Necrosis PANC LIVER GB

29. Normal Pancreas

30. POINTS Grade of Acute Pancreatitis A = Normal pancreas 0 B = Pancreatic enlargement 1 C = Pancreatic/peripancreatic inflammation 2 D = Single peripancreatic fluid collection 3 E = Multiple fluid collections 4 Grade E = 50% chance of developing an infection and 15% chance of death Degree of Necrosis No necrosis 0 Necrosis of one third of pancreas 2 Necrosis of one half of pancreas 4 Necrosis of more than one half 6 CT Severity Index = Grade + Degree of necrosis

31. * > 7 days in the ICU CT Severity Index = Grade of Panc. + Degree of Necrosis per Balthazar MORTALITY MORBIDITY*

32. Cullen’s sign

45. Grey-Turner’s sign

53. Endoscopic Pseudocyst Management

54. Percutaneous Pseudocyst Drainage Open Cystgastrostomy

55. Laparoscopic Cyst Gastrostomy

57. Questions?